As healthcare workers we have been called to provide care to others. This may often mean we do not take time to care for ourselves. During this stressful time, we want to provide you with some helpful resources to use in your own care.
The best way to process your feelings and grief is by talking about them. Anxiousness, depression, increased substance use, and insomnia are all common among anyone dealing with COVID-19, but especially for healthcare workers experiencing it every day. Find worksheets, podcasts, videos and more to help yourself feel better and less stressed.
If you are having a crisis and need immediate assistance, please call the suicide prevention lifeline at 9-8-8 or text HOME to 741741.
Curious about research behind guided self-help?
- Guided internet-based vs face-to-face CBT for psychiatric and somatic disorders – a systematic review and meta-analysis – Andersson (2014)
- Navigating the ethics of Internet-guided self-help interventions – Borgueta (2017)
- Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety – Cuijpers (2010)
Anxiety Resources
Dealing with Stress during the Outbreak
A strong service-orientation, a lack of time, difficulties in acknowledging or recognizing their own needs, stigma, and fear of being removed from their duties during a crisis may prevent staff from requesting support if they are experiencing stress reactions. Given this, employers should be proactive in encouraging supportive care in an atmosphere free of stigma, coercion, and fear of negative consequences.
Self-care for health care workers can be complex and challenging, given that people in these roles may prioritize the needs of others over their own needs. Therefore, a self-care strategy should be multi-faceted and phased properly to support the sense of control and contribution of health care providers without making them feel unrealistically responsible for the lives of patients.
(Adapted from National Center for PTSD; US Dept of Veterans Affairs)
Helpful Work Shift Behaviors:
- Self-monitoring and pacing
- Regular check-ins with colleagues, family, and friends
- Working in partnerships or in teams
- Brief relaxation/stress management breaks
- Regular peer consultation and supervision
- Time-outs for basic bodily care and refreshment
- Regularly seeking out information and mentoring to assist in making decisions
- Keeping anxieties conscribed to actual threats
- Doing their best to maintain helpful self-talk and avoid overgeneralizing fears
- Focusing their efforts on what is within their power
- Acceptance of situations they cannot change
- Fostering a spirit of fortitude, patience, tolerance, and hope
Work Shift Behaviors To Avoid:
- Working too long by themselves without checking in with colleagues
- Working “round the clock” with few breaks
- Feeling that they are not doing enough
- Excessive intake of sweets and caffeine
- Engaging in self-talk and attitudinal obstacles to self-care, such as:
- “It would be selfish to take time to rest.”
- “Others are working around the clock, so should I.”
- “The needs of survivors are more important than the needs of helpers.”
- “I can contribute the most by working all the time.”
- “Only I can do. . ..”
(Adapted from National Center for PTSD; US Dept of Veterans Affairs)
Links
- Guide to Living with Worry and Anxiety Amidst Global Uncertainty
- Managing Healthcare Workers’ Stress Associated with the COVID-19 Virus Outbreak
- 6 Simple Steps for Self-Compassion During COVID-19
- Nourishing Your Mind and Body: Manage Stress for Better Health
- Staying Resilient During COVID-19
- Self Help – Cognitive-Behavioral Therapy (CBT)
- Anxiety self-help guide
- 4 Self-Care Tips for How to Deal with Anxiety
- Self Help for Anxiety
Anxiety Resources for Parents
Apps
InsightTimer – Apple Download | Google Download
Headspace – Free for Healthcare Workers
Calm – Apple Download | Google Download
Covid Coach – Apple Download | Google Download
Podcasts
The Anxiety Guy – Apple Podcasts | YouTube
Not Another Anxiety Show – Apple Podcasts | Stitcher
Videos
- Guided Self-Compassion for Caregivers (10min)
- Short Calming Mindfulness Meditation (6min)
- Mindfulness of Breath (12min)
- UC San Diego Center for Mindfulness
- Includes many options for guided audio and video exercises
Depression Resources
Links
Apps
Virtual Hope Box – Apple Download | Google Download
Podcasts
The Hardcore Self Help Podcast – Apple Podcasts | Stitcher
Insomnia Resources
Links
- Sleep Tools & Tips
- Healthy Sleep Tips
- Sleep Hygiene
- Relaxation Exercises for Falling Asleep
- Shift Work – Treatment
- Shift Work Sleep Tips
- Therapy for Sleep Disorders
- Self-Care Options for Insomnia
- Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
- Tools and Tricks to Calm Your Anxiety and (Finally) Get Some Sleep
Apps
InsightTimer – Apple Download | Google Download
Headspace – Free for Healthcare Workers
Calm – Apple Download | Google Download
Veterans CBT-i Coach – Apple Download | Google Download
Podcasts
Guided Sleep Meditation Spotify Podcast – Spotify
Substance Use Resources
Links
Alcohol
Other Drugs
Apps
12 Steps AA App – Apple Download | Google Download
I Am Sober – Apple Download | Google Download
SoberTool – Apple Download | Google Download
Recovery Box – Apple Download
Someone Died in My Care
Links
- Anticipatory Grief
- Collective Vulnerability during COVID-19 (3 min)
- Loss and Grief During the Coronavirus Pandemic
- Grief and Loss in the Workplace During COVID-19
- A guide to supporting others through grief
- Bereavement & Grief
- 5 Coping Skills to Work through Grief
- Coping with Ambiguous Loss
- “Ambiguous loss is an uncertain loss without clear boundaries or resolution.”
- How to cope with ‘Disenfranchised Grief’ – Mourning losses even when they seem small
Podcasts
Unlocking Us: Grief & Finding Meaning – Listen here
Grief Out Loud Podcast – The Dougy Center
Terrible, Thanks for Asking Podcast – Apple Download | Google Download
Strategies for Mitigating Psychological Distress in Healthcare Providers
- Communicate. Communicate with colleagues clearly and in an optimistic manner. Identify mistakes or deficiencies in a constructive manner and correct them. Compliment each other—compliments can be powerful motivators and stress moderators. Share your frustrations and your solutions. Problem solving is a professional skill that often provides a feeling of accomplishment even for small problems.
- Monitor basic needs. Be sure to eat, drink and sleep regularly. Becoming biologically deprived puts you at risk and may also compromise your ability to care for patients.
- Take a break. Give yourself a rest from tending to patients. Allow yourself to do something unrelated to the traumatic event that you find comforting, fun or relaxing. Some people may feel guilty if they are not working full- time or are taking time to enjoy themselves when so many others are suffering. Recognize that taking appropriate rest leads to proper care of patients after your break.
- Connect. Talk to your colleagues and receive support from one another. Infectious outbreaks can isolate people in fear and anxiety. Tell your story and
listen to others’ stories.
- Reach out. Contact your loved ones, if possible. They are an anchor of support outside the healthcare system. Sharing and staying connected may help them better support you.
- Understand differences. Some people need to talk while others need to be alone. Recognize and respect these differences in yourself, your patients and your colleagues.
- Stay updated. Participate in meetings to stay informed of the situation, plans and events.
- Check in with yourself. Monitor yourself over time for any symptoms of depression or stress disorder: prolonged sadness, difficulty sleeping, intrusive memories, hopelessness. Seek professional help if needed.
Honor your service. Remind yourself that despite obstacles or frustrations, you are fulfilling a noble calling—taking care of those most in need. Recognize your colleagues—either formally or informally—for their service.
Adapted from: Center for the Study of Traumatic Stress
I Know Someone in Crisis
As helping professionals, we are focused on caring for others. This fact makes it very likely that we will see the signs of distress in our colleagues, and may notice it before they recognize it themselves.
Links
Apps
Columbia Suicide Severity Rating Scale Apple Download | Google Download
The Jason Foundation: A Friend Asks Apple Download | Google Download
I'm Having Suicidal Thoughts
9-8-8
Apps
Columbia Suicide Severity Rating Scale Apple Download | Google Download
MY3 App Apple Download | Google Download
With MY3, you define your network, and your plan to stay safe. With MY3 you can be prepared to help yourself and reach out to others when you are feeling suicidal.
General Self-Help Resources
Links
- Physician Support Line provides information and tips on coping with the pandemic, boredom, anxiety, and sleep, among other topics. This information is applicable beyond physicians.
- Mental Health America: Frontline COVID-19 Workers provides many links to various mental health concerns from healthy ways to release rage, managing frustration as communities reopen, building your emotional PPE, among others.
- Scotland’s National Health Information Service provides information and self-help guides to a variety mental health topics.
- Institute for Clinical Systems Improvement offers mental health support for COVID-19 Caregivers.
- North Dakota Behavioral Health Division COVID-19 resources
- Compassion Resilience Toolkit: Staying Resilient during COVID-19 This page has information on topics like the states of fatigue, relationships during social distance, managing expectations, etc.
Podcasts
- Coping Through Covid Podcast via Hartford HealthCare
- NPR Coronavirus Podcast Playlist: Manage Stress and Stay Informed
- The One You Feed Podcast
- Topics: Anxiety, Depression, Substance Use, Habits and Behavioral Changes, Mindfulness
Worksheets
Government of Western Australia’s Centre for Clinical Interventions has put together self-guided worksheets and informational items for a variety of mental health conditions – View Resources
Apps
COVID Coach – Apple Download | Google Download
San Francisco Dept. of Psychiatry and Behavioral Sciences – Psychiatry.ucsf.edu
Burnout
A snapshot from the VA Whole Health Library
What is burnout?
Christina Maslach, who created the widely-used Maslach Burnout Inventory, defines it as “erosion of the soul caused by deterioration of one’s values, dignity, and spirit.”
Burnout symptoms do not just come and go; they remain for a prolonged period of time (weeks to months). There are 3 general categories of symptoms tied to burnout.
Emotional exhaustion
People who are burnt out have limited emotional resources to bring into encounters with others. They feel overextended, overworked, and numbed to situations that normally would have led them to feel empathy or compassion.
Depersonalization
Those suffering from burnout treat colleagues and patients as objects rather than as human beings. They are often cynical and detached. Perspectives change for burnt out clinicians. Jones, the delightful man in the Emergency Department who has 23 grandchildren, just celebrated his 60th anniversary, and whose goal is to visit the Vietnam Memorial in DC, is diminished to being known as “the belly pain in bed 12.”
A sense of low personal accomplishment
People with burnout feel their work does not make a meaningful difference. They feel ineffective and have negative feelings about themselves. Burnt out clinicians are unable to appreciate what they do for their patients and others in their lives.
Who experiences burnout?
Anyone can experience burnout, but it is most likely to occur in people whose professions focus on helping or caring for others.
The following are burnout statistics for different groups of clinicians:
40-61% of over 15,000 physicians from 29 different specialties surveyed were identified as burnt out. (From the 2018 Medscape Physician Lifestyle & Happiness Report)
Women physicians are 1.6 times more likely to report burnout than men.
Burnout begins early in training; 53% of medical students surveyed at 7 medical schools reported symptoms of burnout.
Residents and fellows have some of the highest burnout rates, with up to 80% of residents in some specialties reporting burnout.
In a study of over 7,900 surgeons, 40% reported burnout. 30% screened positive for depression, and 6.4% had suicidal ideation.
It may be that nurses suffer more stress and burnout than any other professional group.
- Well over 40% of nurses report burnout symptoms.
- Only 2/3 of staff nurses in hospitals and 2/5 in nursing homes report satisfaction with their work.
- A sampling of 9959 oncology nurses reported that 30% experienced emotional exhaustion, 15% depersonalization, and 35% a sense of low person accomplishment.
- For a group of 1,110 primary care nurses those rates were 28%, 15%, and 31%.
As many as 60% of psychologists also struggle with burnout.
A 2018 review of 40 studies concluded that over half of all psychotherapists experience moderate to high levels of burnout.
A 2005 study of 751 practicing social workers found a current burnout rate of 39% and a lifetime rate of 75%.
Links
- 9 Tell-tale Signs of Employee Burnout
- Clinician Wellness: Building Resiliency in the Primary Care Home Team (Webinar: 60min)
- This site also has handouts and exercises for resilience and burnout prevention.
Apps
Provider Resilience – Apple Download | Google Download
Posttraumatic Stress & Posttraumatic Growth
Stress
Psychological trauma experienced by healthcare workers (HCWs) during the COVID-19 pandemic can cause PTSD.
Research conducted by Bayazit et al. (2022) investigated the mental health impact of COVID-19 on healthcare workers in Turkey, specifically the rates of PTSD among this population. Some notable findings:
- The rate of PTSD among HCWs was 39.9%
- They found the rate of PTSD did not differ between HCWs who worked on a COVID-19 unit and those that did not. However some symptoms were rated with higher severity such as hyperarousal, feeling isolated, having suicidal ideation, and worry about being assaulted.
- The HCWs who were female, single, non-physicians, felt isolated, and had suicidal ideation had higher rates of PTSD than those who did not.
- Non-physician HCWs had a higher rate of ptsd (49.5% vs 36%) than physicians.
- They discuss similar studies replicated in other countries such as Norway, Australia, China, and Pakistan.
Growth
Not everyone who experiences a traumatic event (or events) will develop PTSD.
Posttraumatic growth is a theory by Tedeschi and Calhoun that holds that people who experience traumatic events or who endure psychological struggles that challenge pre-trauma beliefs and worldviews can often see positive growth afterward.
This growth can include improved relationships, new possibilities for one’s life, a greater appreciation for life, a greater sense of personal strength and spiritual development.
O’Donovan & Burke (2022)completed a systematic review of the literature on Factors associated with PTG in healthcare professionals
Individual Factors for PTG
Work related
- Self-confidence
- Self-efficacy
- Personal Accomplishment
- Meaning in work
- Awareness of Risk
- Demographic factors: years working, education, occupation/role
Non Work Related
- Self-compassion
- Subjective wellbeing
- Wisdom
- Resilience
- Optimism
- Peri-traumatic Disociation
- Coping Strategies
- Demographic Factors: age, sexuality, gender, substance control
Interpersonal Factors
- Relational Support
Work Environment
- Workload
- Patient Population
Psychological Intervention
- Deliberate Rumination
- Challenges to core beliefs
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